| NPI | 1750877569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NV 7309) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 34073) |
| 1223G0001X Dentist General Practice (Licence: NM DD5043) | |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2021-08-23 |